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Your Rights to Buy a Medicare Supplement

buy a Medigap policy when you have a guaranteed issue right

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A Medicare Supplement (Medigap) policy is health insurance sold by private companies to fill the gaps in Original Medicare coverage. Medigap policies help pay some of the expenses that Original Medicare does not cover. In this post, we will explain when to buy a policy and talk about guaranteed issue rights. 

What to Know About Buying a Medigap Policy

Here’s what you should know about buying Medicare Supplement Insurance:

  • It’s best to buy a policy during your 6-month open enrollment period. 
  • You may struggle to find a policy if you don’t buy during this period. 
  • If you are outside your Medigap open enrollment period, you will have guaranteed access to a policy in some situations. 

What Is a Guaranteed Issue Right?

A Medigap guaranteed issue right means you can buy a Medicare Supplement policy from any carrier regardless of your health condition. Your guaranteed issue rights only apply in certain situations.  

When you have a guaranteed issue right, insurers must sell you a Medicare Supplement policy at the best available rate — even if you have pre-existing conditions. In these cases, carriers can’t charge you more due to past or present health issues.  

Note: If you live in Wisconsin, Minnesota, or Massachusetts, you have guaranteed access to a Medigap policy, but the policies are different. 

When Do You Have Guaranteed Issue Rights? 

Most of the time, you have a guaranteed issue right when you have other health coverage that changes, like when you lose the other coverage. Sometimes you have a “trial right” to test a Medicare Advantage plan and still buy a Supplement policy if you reconsider. 

If you are 65 or older, you have a guaranteed issue right — within 63 days of losing certain health coverage.

Medigap Guaranteed Issue Right Situations 

The chart below lists common situations that give you a right to buy a Medigap policy (under federal law). The tables also describe the type of plan you can purchase and when you can or have to apply for them. Some states may offer additional Medigap guaranteed issue rights.      

You have a guaranteed issue right IF:You have the right to purchase:You can/have to apply for a policy:
You’re enrolled in a Medicare Advantage plan, and the plan is leaving Medicare or stops providing care in your area, OR you move out of the service area.Medigap Plan A, B, C, D, F, G, K, or L that is sold in your state by any carrier. 
You only have this right if you switch to Original Medicare instead of joining another Advantage program. 
As early as 60 days before the date your SELECT coverage will conclude, but no later than 63 days after this coverage ends.
Medigap coverage can’t kick in until your Medicare Advantage plan coverage ends.
You have Original Medicare and an employer group health plan or union coverage that chips in after Medicare pays, and that plan is ending. 
In this case, you might have additional rights under state law.
Medigap Plan A, B, C, D, F, G, K, or L that is sold in your state by any carrier. 
If you have COBRA coverage, you can purchase a Medigap policy immediately OR delay until the COBRA coverage ends. 
Up to 63 days after the latest of the following dates:
-Date the coverage ends
-Date on the notice you get saying that coverage is ending
-Date on a claim denial
You have Original Medicare and a Medicare SELECT policy. You move out of the SELECT policy’s service area.Medigap Plan A, B, C, D, F, G, K, or L — that is sold by any insurance carrier in your state or the state you’re relocating to. As early as 60 days before the date your SELECT coverage will conclude, but no later than 63 days after this coverage ends.

Note: Medigap Plans C and F are no longer available to those who are new to Medicare after January 1, 2020. However, if you were eligible before January 1, but not yet enrolled, you may be able to buy these plans. Folks eligible for Medicare after January 1 have the right to buy Plans D and G rather than Plans C and F. 

Medigap Guaranteed Issue Right Situations — Continued

You have a guaranteed issue right IF:You have the right to purchase:You can/have to apply for a policy:
Trial right – You enrolled in a Medicare Advantage plan when you were first eligible for Medicare Part A (at 65), and you decide you want to switch to Original Medicare within the first year of joining. Any Medigap policy sold in your area by any insurance carrier.As early as 60 days before the day your coverage will conclude, but no later than 63 days after your coverage ends. 
Note: Your rights may last for an additional year under certain circumstances.
Trial right – You dropped a Medigap policy to join an Advantage plan for the first time, you’ve been in the program for less than a year, and you wish to switch back.The Medigap policy you had before you joined the Advantage plan, if the same carrier you had before sells it. 
If your previous policy isn’t available, you can buy Medigap Plan A, B, C, D, F, G, K, or L that is sold in your area by any carrier. 
As early as 60 days before the day your coverage will conclude, but no later than 63 days after your coverage ends. 
Note: Your rights may last for an additional year under certain circumstances.
Your Medigap carrier goes bankrupt and you lose your coverage, OR your policy coverage ends without it being your fault.Medigap Plan A, B, C, D, F, G, K, or L that is sold in your state by any insurance carrier. Up to 63 days from the day your coverage ends.
You leave an Advantage plan or drop a Medigap policy because the company misled you or has failed to follow the rules.Medigap Plan A, B, C, D, F, G, K, or L that is sold in your state by any insurance carrier. Up to 63 days from the day your coverage ends.

Can You Buy a Medigap Policy If You Lose Your Health Care Coverage? 

Yes. Since you may have a guaranteed issue right to purchase a policy, keep the following:

  • A copy of letters, emails, notices, or claim denials that have your name on them — as proof of your coverage being cancelled. 
  • The postmarked envelope these papers were mailed in — as proof of mailing date.

If you have a Medicare Advantage Plan, such as an HMO or PPO, but you want to return to Original Medicare, you can apply for a supplement policy before your plan coverage ends. The Medigap carrier can sell it to you — as long as you’re leaving the Advantage program. You can request the new policy to kick in when your Advantage enrollment ends, so you’ll get ongoing health coverage.  

For more information about buying a Medigap policy, call the agents at Bobby Brock Insurance — (662) 844-3300.  

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